HomeMy WebLinkAboutSeptic Repair 2459 Ellington Road • TOWN OF SOUTH WINDSOR
HEALTH DEPARTMENT
Application for permit to install a new/repair subsurface sewage disposal system. To the Health Department,
Town of South Wind or.
Fee Paid 10 —� Date Permit Number
As a subsurface sewage disposal system installer licensed in the State of Connecticut, I
le-'r,hez'Ve2i P P,�*6.q 4-sa-1 i.✓oal�i�se RU E-L/ G?� /3 io&J
Name, Address, Telephone Number, License Number
hereby apply for a permit to construct/repair a subsurface sewage disposal system located at
2y5 9 /� �'iu1 _�G .S �✓i, dse� and owned by tAeo0c,
Street, Address, Lot Number/ Name
Address
Information to be supplied by Applicant:
Type of dwelling --&,. ditmcr If non-residential, estimated daily flow
Residential,Commercial,Etc.
Number of bedrooms 3 Size of lot
Number of fixtures above basement G--"Q .�
Tubs,Sinks,Toilets,Etc.
Number of fixtures in basement, if any ,
J / Pumped or gravity flow,
Type of water supply -00—'U - If private,type of well
Public-Private
Information to be supplied by Health Department:
Soil type at various levels _-See, 7—es7— 0671
Percolation rate Square feet of effective leaching area required
Size of septic tank f DOD Type of system';lr�4Ti — /��y7,p K/ry
n Tr�s,Orywells,Etc.
Number of dry wells, trenches, etc. CQ 25L r Distance between individual leaching
units. Distance from well on same property 'A,ZA on adjoining property Al-4
Curtain drain required
Yes,No
Height of system above ground water , maximum groundwater ,
ledge y f , impervious soil layer
If automatic closing is required,description
A PLOT PLAN INDICATING LOCATION OF PROPOSED STRUCTURE, WATER SUPPLY, SEPTIC SYSTEM, EM-
BANKMENTS, WATERCOURSES, PROPERTY LINES AND ALSO IN-DICATING EXISTING AND PROPOSED
FINISHED GRADES MUST BE SUBMITTED BEFORE THIS PERMIT CAN BE ISSUED.
THIS PERMIT IS NOT TRANSFERRABLE FROM PERSON TO PERSON OR FROM PLACE TO PLACE.
NO PART OF THE SYSTEM H S ALL BE BACKFILLED UNTIL IT HAS BEEN INSPECTED AND APPROVED BY THE
SANITARIAN.
SPECIFICATION AND REQUIREMENTS AS STATED IN THIS PERMIT MUST BE MET AND ANY CHANGES MUST
BE APPROVED BY THE TOWN SANITARIAN BEFORE FINAL APPROVAL WILL BE GIVEN.
THIS PERMIT SHALL NOT BE CONSTRUED AS PERMISSION TO CREATE A NUISANCE CONDITION NOR IS
THIS SYSTEM GUARANTEED BY THE HEALTH DEPARTMENT.
Permit Received by Date — 17 `D 3
Si94at of Applicant&License Number
For Office Use Only
Permit issued by Date
System installed by
Final Inspection Approval Date 9^17—d3
PIPPIN & SON SEPTIC SERVICE
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lIre ,- (860)875-7472
c�S (860)623-2313-
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OWNER _ c,.�e i'` LOCATION ,2 V S`f
PERCOLATION TESTS: (Record all tests) 4-03
SOIL MOISTURE:� ew
DATE (high, med, low, etc)
_ TEST READINGS
HOLE#I HOLE#Z
Time Readin HOLE#3 HOB
Time Readin Time 11 �7 1 Z _ j, � Readin Time Readin
11 S'Z
TABULATION OF TEST RESULTS
Hole Location
Death Presoak Minimum Percolation Rate
inches_ ffikiAnch
1.
2. r l J &(- (. ��►
3.
OBSERVATION PITS: (Record all pits) j
^ �® Ground Water Table:
(Date)
(Near Below Max)
P
IT A SOIL DESCRIPTIONS
PIT B PTT C
o, d2 „T&p PTT D
t2 f"dam - �-� P J-Jv f 1 ,, fk•cc�f; r
ItAt
, L leo
ydtL 2y
f®�f 2yei !tom
1oc��faa
01
IL 35 ,P
re- r,
70
t
C= +u
A
De—Lh d qt
ChOUAd $01l y
Water at
B. Mo•--nlm
C.
D.
SPECIAL, CONDITIONS
SYstem design larger than 2,000 g.p.d.
Water Supply watershed
Hrgh ground water(less than 4 1/2 1I.)
Possible seasonal high ground water
Watercourse,marsh or pond
Limited suitable area Possible seasonal flooding
Slop
Marginal soil(30-60 mins�nch)
U„derlrng ti Sballoty ledge(less tha 7 n ft) �.ght soil(less than 41})
— Other
ONCI,USION
Suitable for selvage disposal
Unsuitable for selvage disposal Retest during wet season
Additional investi Er sinter s plan reed
gation required
DESIGN RECOMMENDATIONS
c!
001
a
'vestigated by
ride
'nSrmed(Witnessed by i c
�F Title
Mznents:
fi mark location
amseemolloy/dVada 99rnvenisst"'for sewage disposal sy
�,,, Elevation